Medical Diagnosis
Causes of IBS
Traditional Approaches to IBS Treatment
Holistic Approaches to IBS Treatment
KE-99 LACTO(TM) as part of Managing IBS Symptoms
IBS Resources
IBS Success Stories

Medical Diagnosis
As was mentioned above, IBS is a "functional" disorder meaning that there are symptoms described by the patient but there is no measurable physiological abnormality. Until relatively recently IBS was very much a hidden condition with many sufferers simply enduring the symptoms because of embarrassment. Prior to 1960 IBS was very little understood and often misdiagnosed since no real standards or medical consensus existed. Even now, with increased attention and research and estimates that this condition accounts for 12% of primary care and 28% of gastroenterological practice, up to 70% of persons with IBS symptoms do not seek medical attention. In 1979 an attempt was made to classify intestinal symptoms found in IBS (non organic) patients and this study known as the "Manning Criteria" became the standard for diagnosing IBS. Adrian Manning and his associates identified six symptoms differentiating IBS:

1. Relief of abdominal pain with defecation.
2. Looser stools with the onset of pain.
3. More frequent bowel movements at the onset of pain.
4. Abdominal bloating or distention.
5. Feelings of incomplete evacuation.
6. Passage of mucus.

In general, the more of these symptoms the patient had the more likely that the patient had IBS. This preliminary study has been refined and built upon by a series of medical conferences held in Rome producing a set of diagnostic criteria which is widely accepted by the medical and scientific community. These "Rome Diagnostic Criteria for Irritable Bowel Syndrome" allow for a diagnosis of IBS when there is least 3 months of continuous or recurrent symptoms of the following:

1. Abdominal pain or discomfort relieved with defecation or associated with a change in frequency of stool or associated with a change in consistency of stool and

2. Two or more of the following at least on 1/4th of occasions or days
- Altered stool frequency (for research purposes defined as more than three bowel movements each day or less than three bowel movements each week), or
- Altered stool form (lumpy/hard or loose/watery stool), or
- Altered stool passage (straining, urgency, or feeling of incomplete evacuation), or
- Passage of mucus, or
- Bloating or feeling of abdominal distention.

For additional information and resources on the Rome and Rome II criteria visit the website for the Rome Committee at http://www.romecriteria.org/index.html

Depending on the severity of the symptoms suffering from IBS symptoms, especially those meeting the above criteria, may want to undergo a physical examination to rule out certain organic conditions including diverticulitis, ulcerative colitis, internal parasites and Crohn's disease. Depending on the exact symptoms the physician may suggest blood chemistries, stool tests for parasites and blood, sigmoidoscopy or colonoscopy or other tests to rule out organic conditions. Meeting the Rome Criteria for IBS in the absence of one of these organic conditions would confirm the diagnosis of Irritable Bowel Syndrome.

Causes of IBS
There are multiple causes for IBS and IBS like symptoms and even for a particular individual there can be multiple contributing factors. It is well known that stress plays a part and bouts of IBS symptoms are often triggered by major stress events such as divorce, death of a loved one or a career change. Certain foods trigger outbreaks in some patients. Although there is no one single food trigger many people react to dairy foods, beans, raw fruit and vegetables, chocolate, stimulants like caffeine and tobacco, depressants like alcohol and non-nutritive sweeteners like Sorbitol and Xylitol . Lack of fiber in the diet and overeating also seem to trigger IBS outbreaks. Pathogenic bacteria in intestinal tract are an important aspect in IBS both as a causative factor and as a symptom as other symptoms can actually cause us to loose beneficial bacteria and allow pathogenic bacterial growth. From a practical standpoint each sufferer from IBS and IBS like symptoms has to observe carefully which of these factors is present and seems to contribute to his or her IBS symptoms. Through this process of observation the group of causative factors needs to be determined before a management program can be designed.

Traditional Approaches to Treatment
In the past the traditional treatments for IBS and IBS like symptoms have included medications for pain and bloating, antidepressants, diarrhea medications and psychological treatments and even treatment with antibiotics. Anti-spasmodic drugs like Bentyl and Levsin and smooth muscle relaxants have been prescribed for abdominal pain antacids and anti-gas medication to reduce flatulence. In the majority of cases these treatments resulted in only partial, temporary relief from the symptoms while exposing patients to habit forming drugs and drug side effects. In February of 2000 the FDA approved a new drug called Lotronex specifically aimed at IBS sufferers only to pull the drug off the market 10 months later after reports of serious side effects including intestinal damage and severely obstructed or ruptured bowels. Traditional medical approaches alone for this type of non-organic syndrome (as opposed to a structural or inflammatory bowel disease) have not proved effective. Once other diseases have been ruled out IBS and IBS like symptoms seem to be best managed with a less invasive and more holistic approach.

Holistic Approaches to Treatment
A holistic approach to managing IBS and IBS like symptoms can be envisioned as three steps, first to identify causative factors and triggers for IBS attacks, second to make diet, lifestyle and supplement modifications and third, to observe and refine the process. The degree and amount effort you put into this approach can vary with the severity of your symptoms and adjusted as improvement is made. The good news is that IBS and IBS symptoms can be managed effectively. 10% of these with IBS symptoms have significant improvement each year with almost 50% asymptomatic 5 years after diagnosis and treatment. No link has been found between IBS and colon or rectal cancer; in fact their better awareness may make IBS sufferers more aware of cancer prevention. Below is a listing of some of the causative agents and lifestyle, food and supplement modifications to help manage them.

Stress - Anxiety and stress are major components in many IBS attacks, but is role for any individual has to be determined by that individual by observation. For most of us, reducing stress is a move in the direction of better health and there are many resources available to help with this. A start could be taking a minute or two during the day to take some deep breaths and relax. Yoga and meditation have been used to reduce stress for thousand of years. Depending on the severity of symptoms and the role stress plays, looking at stress/anxiety factors in your life and moving gradually to simplify and reduce some of them could be indicated. Other stress reducing options include increased exercise and various psychological therapies (including hypnosis therapy and cognitive behavioral therapy).

Foods - An approach here might be to jot down various foods consumed and note when they are followed by IBS symptoms. Another approach is to eliminate various foods (especially those that seem to be trigger foods for many IBS sufferers) for a time and see if there is a lessening of symptoms. IBS patients often eliminate all lactose containing (dairy) foods as a first step as lactose seems to be at least a factor for a great many people. Stimulants like caffeine and tobacco likewise often irritate the intestinal tract and can make symptoms like diarrhea worse as can non-nutritive sweeteners like Sorbitol and xylitol. On a more selective basis we suggest looking at foods like beans, raw fruit and vegetables, chocolate, MSG, refined carbohydrates (starches and sugars), carbonated beverages and alcohol to see what if any role they play. In a more general sense eating too much at any particular meal, eating too often or eating too much of a particular type of food (fats, oils or fried foods for instance) can put a strain on the digestive system, impair digestion and absorption and aggravate symptoms. The goal in this holistic approach is to gradually refine your diet and eating habits and reduce or eliminate the foods and behaviors that contribute to IBS symptoms.

Supplementation - There are a number of supplements to the diet which have been used successfully by IBS patients to alleviate symptoms. From what we know today, by far the most important supplementation for the IBS sufferer is probiotic supplementation! Studies indicate that lactobacillus bacteria even as the only treatment can have a significant effect on IBS symptoms (Treatment of Irritable Bowel Syndrome...American Journal of Gastroenterology, 91: 1579-1585, 1966.). As mentioned above, pathogenic bacteria in the intestinal system can be both a causative factor and the result of IBS symptoms. Probiotics are beneficial bacteria that attack and reduce pathogenic bacteria allowing for the restoration of intestinal balance necessary to proper digestion. For these reasons, supplementation with an effective probiotic is an essential part of effectively managing IBS and IBS like symptoms. Other supplements which have been successful for some patients with IBS include, peppermint oil, slippery elm powder (for healing irritated tissues), mint leaves, ginger, chamomile and insoluble fiber either through enough whole grain and vegetables or ground flax seeds or use of a Metamucil type fiber supplement.

KE-99 LACTO™ As Part of Managing IBS Symptoms
Probiotic supplementation is an effective and necessary part of the treatment of IBS and of managing IBS like symptoms. We recommend KE-99 LACTO™ for this supplementation for two important reasons. First, it has been proven to consistently outperform competitive products in its ability to attach to enteric sites and compete with and reduce the pathogenic bacteria that can contribute to IBS symptoms. Second, the particular KE-99 lactobacillus casei stain was isolated for its property of being less fragile than other beneficial bacteria strains. Since most strains are very fragile and largely die off before they can have any effect, they are of little help to the IBS sufferer! As a much stronger strain, KE-99 LACTO™ can also be shipped to you (without refrigeration) and still maintain optimum viability.

KE-99 LACTO™ comes in two forms, in a bottle of coated, chewable tablets which is refrigerated after opening and in a box of 30 individual, nitrogen flushed foil packets each containing two capsules, which never need refrigeration. The foil packets are ideal for IBS sufferers in that they can be easily transported and taken with meals away from home, and when traveling.

IBS Resources
IBS Success Stories

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